Gastrointestinal endoscopy clinics of North America
-
Gastrointest. Endosc. Clin. N. Am. · Apr 1999
ReviewPharmacologic intervention during the acute bleeding episode.
The risk of recurrent variceal bleeding after an acute episode of bleeding has been controlled in significant with rebleeding rates as high as 80% between one and two years. Pharmacologic therapy has a definite role in the prevention of recurrent variceal bleeding and should be started as soon as the acute bleeding event has been controlled. ⋯ Non-selective beta-blocker therapy is a reasonable first line approach followed by the addition of a long-acting nitrate for patients not achieving a 20% reduction in the hepatic venous pressure gradient. Most patients will require combination pharmacotherapy or combined endoscopic therapy with pharmacotherapy.
-
Gastrointest. Endosc. Clin. N. Am. · Jul 1998
ReviewSurgical and laparoscopic techniques for feeding tube placement.
Surgeons have at their disposal multiple options for providing enteral access in a myriad of circumstances. This article reviews the techniques for surgical placement of enteral access as well as the indications, benefits, and complications for each procedure. The feeding tubes commonly available are described, and considerations involved in the choice of procedure are discussed.
-
Gastrointest. Endosc. Clin. N. Am. · Jul 1998
Ethical issues in instituting and discontinuing enteral feeding.
The shift from inpatient care has not lessened the importance of ethical issues in caring for patients. Dilemmas involving withholding and withdrawing enteral nutrition require input from the patient, family, and caregivers. Decisions to forego or discontinue treatment such as home enteral support should never be distinguished from the responsibility of providing support and compassionate care throughout life, even during dying.
-
Gastrointest. Endosc. Clin. N. Am. · Jul 1998
ReviewEnteral feeding in critical care, gastrointestinal diseases, and cancer.
This article discusses the many advantages and changes that have occurred in the nutritional management of critically-ill patients, patients with gastrointestinal diseases, and patients with selected cancers. Mechanical obstruction is the only absolute contraindication to enteral nutrition. This article reviews the present aggressive approach to the use of enteral nutrition.
-
Gastrointest. Endosc. Clin. N. Am. · Jul 1997
ReviewColon cancer screening. Sigmoidoscopy or colonoscopy.
Colorectal cancer is a common neoplasia with high morbidity and mortality. With endoscopy it is possible to identify its precursor lesion, the adenoma, and early localized cancer. Early detection and removal of adenomas can reduce the incidence and mortality of this disease. ⋯ Colonoscopy also may help to stratify at-risk patients, and those with negative initial colonoscopy may not need further screening. Advances in molecular biology may provide markers for screening or identifying people who are at high risk for colorectal neoplasia. This development may allow screening to be directed at high-risk groups.